Patients check in at Clinica Sierra Vista's Lamont Community Health Center in Bakersfield, California October 20.

Phil McCarten/Reuters/File

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Washington — As with abortion, illegal immigration has emerged as a social-issue flashpoint in healthcare reform.

The House bill, which passed Nov. 7, allows undocumented immigrants to purchase health insurance from a newly organized marketplace, or “exchange,” if they use their own money and receive no federal subsidy. The Senate bill, which begins its legislative journey on Saturday, bars illegal immigrants from using even their own money to buy insurance in the exchange.

Supporters of the House approach believe that allowing undocumented immigrants access to private health insurance, if it is not provided through their employer, would cut down on visits to the emergency room and thus would reduce everyone’s healthcare costs. Typically, healthcare providers pass along at least some of the costs of uncompensated care to paying customers.

“If they use their own money to purchase insurance without any taxpayer subsidy, it would make a lot of sense to offer that possibility,” Sen. Robert Menendez (D) of New Jersey said Thursday on ABC’s “Top Line” webcast.

Still, Senator Menendez does not intend to introduce an amendment when the Senate bill reaches the floor, says his press secretary, Afshin Mohamadi. “He’s going to look at the totality of the bill and judge it based on that, not one particular issue or another,” says Mr. Mohamadi.

Senator Menendez is the only Hispanic member of the Senate. If the Senate bill stands as is, then the immigration issue will have to be hashed out in conference. House speaker Nancy Pelosi has said she will stand by her chamber’s version.

But even given that the House version disallows a federal subsidy for an undocumented worker’s health insurance, supporters of the House position may still have to fight a perception that such workers are gaining inappropriately under health reform. Critics of the House provision fear the government will look the other way as illegal immigrants get subsidized healthcare. They doubt that such workers’ immigration status will be checked.

It was President Obama’s comment about illegal immigrants in a speech to a joint session of Congress in September that prompted Rep. Joe Wilson (R) of South Carolina to shout out, “You lie!” Obama had said: “There are also those who claim that our reform effort will insure illegal immigrants. This, too, is false – the reforms I’m proposing would not apply to those who are here illegally.”

The Hispanic vote was a crucial piece of Obama’s winning coalition a year ago, and Democrats are hoping to hold onto that more than 2-1 margin in next year’s midterms.

Two days before the House vote on health reform, four members of the Congressional Hispanic Caucus, all Democrats, met with Obama to try to get White House backing for the House version regarding undocumented workers. That did not happen.

House Democratic Hispanics have not indicated what they will do if the Senate’s version makes the final bill, but for now they are putting out a hopeful message. “He is optimistic about the fact that we will be able to come up with something we can all agree on,” said an aide to a Hispanic Democrat speaking on background.